- Email: [email protected]
Dentists and leaders
who will pay for the tests. In addition, they worry that patients will not see the relevance of HIV testing to dentistry, will be upset or alienated by the experience, or will not receive the sensitive treatment and discussion appropriate to sexual health matters. Special contractual arrangements may be needed to facilitate the adoption of rapid HIV testing in a dental setting. There may also be a need to regulate the equity of access and uptake of screening issues in dental offices. If dentists become involved in offering HIV screening, patients would need to have complete confidence that the process would be confidential and they would be shown respect from the dental provider regardless of the outcome. Staff training would be essential. Research to determine the attitudes of dental staff and dental patients regarding HIV testing is needed to design appropriate training courses. Local protocols would have to be observed, and ready availability to sexual health services that will accept referrals for definitive testing, support, and ongoing care would be essential. Dentists and the dental staff should also have access to support and advice from HIV experts. If a dentist offered HIV testing, it may be more appropriate to make it targeted rather than universal, but the logistics for accomplishing this are complex. It is necessary to avoid any prejudicial practices.
Clinical Significance.—Dental staff members are in a unique position with respect to providing preventive support because most people visit their dentist even if they don’t go to a physician. Dentists are highly trained health care providers who are trained and have the experience to present difficult news to patients and ensure that they receive appropriate treatment or a referral. Adding HIV screening tests to dental practice routines could be seen as providing a safe health care environment where referral to appropriate services can be arranged. Self-testing at home may be a more solitary and unsupported method, often accompanied by reluctance to attend sexual health clinics. Oral (salivary) HIV screening tests are in line with dental practice and may seem directly relevant to patients.
Santella AJ, Conway DI, Watt RG: The potential role of dentists in HIV screening. Br Dent J 220:229-233, 2016 Reprints available from AJ Santella, Hofstra Univ, Dept of Health Professions, Hempstead, New York; e-mail: Anthony.Santella@ hofstra.edu
Leadership Dentists and leaders Background.—Trends indicate that the future of dentistry appears to involve an increased number of multidisciplinary teams that deal with oral health and a reduction in the number of solo practices. Dentists are often drawn to their profession because of the strong possibility that they will be able to function as a solo practitioner in their own offices. This desire for independence may make them more suitable as managers of a team and less suitable as a leader than they may think. The characteristics of dentist-managers and those of leaders were considered (Table 1). Dentist-Managers.—Dentists who own and manage their own practice tend to work alone and without much feedback from colleagues or other health care professionals. His or her staff members remain subordinates. The dentist gives instructions and expects that they will
be followed. Very little negotiation or persuasion is needed because subordinates recognize that the dentist is the manager of the practice. Noncompliance is not generally an option for dental staff. The understanding that an employee could lose his or her position for noncompliance makes the relationship transactional rather than influential in nature. Dentists tell staff and patients what to do and the staff gets paid while the patients achieve better oral health. Dentists are highly detail oriented, which makes them good at their work. This can be a problem, however, if they focus on the tooth rather than the patient. Dentists must work to see the patient as an entire entity rather than a case or problem to be solved. Often dentists rely on their technical excellence and ability to communicate one-on-one with a patient or with small
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Table 1.—Characteristics of Good Dentists and Good Leaders Good dentist
Transactional leadership that lead by authority Autonomy and self-reliance Detail oriented Topic expert Controlling Dealing with straightforward problems that usually have a straightforward solution Face little resistance Shy away from giving and receiving feedback Excellence in technical ability Patience, endurance and tolerance Pessimism Evidence based and data-driven decisions
Good leader
Transformational leadership that utilises influence Inter-dependence Creative and ‘big picture’ oriented Not an expert at all Delegating and collaborating Dealing with complex problems that may have counterintuitive solutions Face a lot of resistance Valuing giving and receiving feedback to achieve optimal outcomes Often no technical ability Impatience Optimism Consider data but make intuitive decisions
(Courtesy of Nalliah RP: Do dentists make poor leaders? Br Dent J 220:389-391, 2016.)
groups of individuals, but have difficulty in larger group settings. When dealing with patients, dentists can be frustrated by noncompliance. The feeling is that they have provided the patients with appropriate instructions and the patients should fall in line with the program. This can also translate into a desire to control every aspect of a case. As a result, they often face little resistance—they are the overseers of the case and conflict simply does not arise in that context. Referring patients can be difficult because of this desire to manage every aspect of patient care. Dentists may also have difficulty delegating tasks, preferring instead to perform each procedure themselves. This reflects their fundamental view that they are ultimately responsible for their patients. Often this means that they do not collaborate well with the rest of the health care profession. They see themselves as solo practitioners. Dentists are often poor at giving feedback and even poorer at receiving it. They tend to be perfectionists and see criticism as a threat. Falling short of the goal affects their view of their reputation and could potentially have medicolegal implications. They tend to avoid interactions that include critiques and feedback exchange. Leaders.—Leaders do not have direct authority over every situation, so they must understand and navigate through the sociopolitical and cultural environment and employ negotiation and persuasion to get things done. They require the ability to influence others to support goals and actions. This is an influential relationship rather than a transactional one. Leaders also know how to operate effectively in a team. They know each member of the team, inspire them, and identify the personal value in achieving organizational
298
Dental Abstracts
goals. The team then buys into meeting the goals. Leaders use their charisma and communication skills to create an environment where team members can succeed individually in their pursuit of the organizational goals. Rather than the leader being solely responsible, as with dentistmanagers, responsibility is shared among the team. Good leaders may be less detail oriented than managers. Instead, they have a ‘‘big picture’’ mentality that considers not just individuals but also the entire organization, competing entities, and even the surrounding population or area. Expertise is shared with the team. As a result, leaders feel comfortable delegating and see it as a way to engage with the team as well as reduce their workload. Delegation also enhances the confidence and commitment of the team, further strengthening it. Leaders often do not have the well-defined problems facing them that a dentist routinely handles. Instead, leadership is a complex task with many changes taking place. Many factors are involved and the resolution of a problem can often require counterintuitive steps. Leaders need to understand the implications of their decisions, consider them all, and act. Leaders must also be open to the feedback of many entities. Without gathering feedback and considering others’ opinions the best option may be overlooked. They are adept at evaluating data and assessing how to use it. With the move toward publicly available patient satisfaction data being made by hospitals and other medical or insurance entities, leaders will need to be open to dealing with both negative and positive feedback. Leaders also are able to communicate effectively with large groups, sharing their vision and building a foundation for these individuals to buy into their team and organization. Dentists need to be empathetic and able to communicate
one-on-one, whereas leaders need to effectively employ broad communication skills for a wide range of applications. Althoughdentistsareseenhistoricallyaspatientor tolerant, leaders often cannot afford to wait. They instead tend to be proactive, plan ahead, and can be impatient with delays. Leaders must be transparent and honest, optimistic, and intuitive. Society may have some qualms about the honesty of dentists based on past history. In addition, dentists tend to have a more pessimistic bent, thinking of the possible poor outcomes and worst possible scenarios for patients to meet medico-legal requirements. Dentists often do not take risks and tend to rely on information rather than intuition. Discussion.—If the future of dentistry is larger practices, staff management needs, complex marketing demands, and financial decisions, dentists will require more leadership skills in many cases. Although they possess
characteristics and natural abilities that make them good dentists, these same traits can hinder their ability to lead.
Clinical Significance.—The American Dental Association (ADA) and other dental organizations offer leadership training programs that may benefit dentists. These should be considered essential learning opportunities that will strengthen dentists and their staff.
Nalliah RP: Do dentists make poor leaders? Br Dent J 220:389-391, 2016 Reprints available from RP Halliah, Univ of Michigan School of Dentistry, Patient Services, 1011 N University, Ann Arbor, MI 48105; e-mail: [email protected]
EXTRACTS DRINK WATER FOR HEALTH All the cells, organs, and tissues of the body need water to function properly. Water helps dissolve minerals and nutrients so they are more available for use and it transports waste products out of the body. The body loses water through sweating and urination or even breathing, and it must be replenished regularly. Some water comes through foods with a high water content, but the majority comes from drinking water and other beverages. Although there are individual variations, the Institute of Medicine (IOM) reports an adequate intake of 13 cups (3 liters) a day for men and 9 cups (2.2 liters) for women. Water is especially indispensable for the kidneys. These two fist-sized organs are shaped like beans and found in the middle of the back on either side of the spine and just under the rib cage. ‘‘The role of the kidneys is often underrated when we think about our health,’’ states Kidney Health Australia. ‘‘They are so important to health that nature gave us two kidneys to cover the possibility that one might be lost to an injury. They are so important that with no kidney function, death occurs within a few days.’’ Specific roles include removing waste products and excess fluid from the body via urine, regulating levels of salt, potassium, and acid in the body, and producing hormones to regulate other organs. If the kidneys do not function properly, waste products and excess fluid can build up in the body, which can lead to chronic kidney disease, painful kidney stones, or urinary tract infections. Dehydration can also lead to an imbalance in the electrolyte levels of the body, which can mix up electric signals and produce seizures. Severe dehydration can also be associated with kidney failure, anemia, central nervous system damage, heart failure, and immune system compromise. A study by the Centers for Disease Control and Prevention (CDC) in 2013 used data from the National Cancer Institute’s 2007 Food Attitudes and Behaviors Survey and found that of 3397 adults, 7% did not drink water daily, 36% drank only 1 to 3 cups per day, 35% drank 4 to 7 cups, and 22% drank 8 or more cups. Those who drank less than 4 cups of water a day tended to consume less than 1 cup of fruits or vegetables daily. Water is the ideal way to provide fluid to the body because it is readily available and free of calories, caffeine, and alcohol. The CDC suggests that people increase their water intake by carrying a water bottle that makes it accessible anywhere; freezing water in bottles to provide a supply of ice-cold water, which is often more satisfying than other beverages; and adding a wedge of lime or lemon to improve the taste of water without altering its nutritional value. [McIntosh J: Satisfying Thirst and the Kidneys: The Importance of Drinking Water. Medical News Today, accessed at http://www.medicalnewstoday.com/articles/290814.php]
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Clinical Significance.—Dental staff members are in a unique position with respect to providing preventive support because most people visit their dentist even if they don’t go to a physician. Dentists are highly trained health care providers who are trained and have the experience to present difficult news to patients and ensure that they receive appropriate treatment or a referral. Adding HIV screening tests to dental practice routines could be seen as providing a safe health care environment where referral to appropriate services can be arranged. Self-testing at home may be a more solitary and unsupported method, often accompanied by reluctance to attend sexual health clinics. Oral (salivary) HIV screening tests are in line with dental practice and may seem directly relevant to patients.
Santella AJ, Conway DI, Watt RG: The potential role of dentists in HIV screening. Br Dent J 220:229-233, 2016 Reprints available from AJ Santella, Hofstra Univ, Dept of Health Professions, Hempstead, New York; e-mail: Anthony.Santella@ hofstra.edu
Leadership Dentists and leaders Background.—Trends indicate that the future of dentistry appears to involve an increased number of multidisciplinary teams that deal with oral health and a reduction in the number of solo practices. Dentists are often drawn to their profession because of the strong possibility that they will be able to function as a solo practitioner in their own offices. This desire for independence may make them more suitable as managers of a team and less suitable as a leader than they may think. The characteristics of dentist-managers and those of leaders were considered (Table 1). Dentist-Managers.—Dentists who own and manage their own practice tend to work alone and without much feedback from colleagues or other health care professionals. His or her staff members remain subordinates. The dentist gives instructions and expects that they will
be followed. Very little negotiation or persuasion is needed because subordinates recognize that the dentist is the manager of the practice. Noncompliance is not generally an option for dental staff. The understanding that an employee could lose his or her position for noncompliance makes the relationship transactional rather than influential in nature. Dentists tell staff and patients what to do and the staff gets paid while the patients achieve better oral health. Dentists are highly detail oriented, which makes them good at their work. This can be a problem, however, if they focus on the tooth rather than the patient. Dentists must work to see the patient as an entire entity rather than a case or problem to be solved. Often dentists rely on their technical excellence and ability to communicate one-on-one with a patient or with small
Volume 61
Issue 6
2016
297
Table 1.—Characteristics of Good Dentists and Good Leaders Good dentist
Transactional leadership that lead by authority Autonomy and self-reliance Detail oriented Topic expert Controlling Dealing with straightforward problems that usually have a straightforward solution Face little resistance Shy away from giving and receiving feedback Excellence in technical ability Patience, endurance and tolerance Pessimism Evidence based and data-driven decisions
Good leader
Transformational leadership that utilises influence Inter-dependence Creative and ‘big picture’ oriented Not an expert at all Delegating and collaborating Dealing with complex problems that may have counterintuitive solutions Face a lot of resistance Valuing giving and receiving feedback to achieve optimal outcomes Often no technical ability Impatience Optimism Consider data but make intuitive decisions
(Courtesy of Nalliah RP: Do dentists make poor leaders? Br Dent J 220:389-391, 2016.)
groups of individuals, but have difficulty in larger group settings. When dealing with patients, dentists can be frustrated by noncompliance. The feeling is that they have provided the patients with appropriate instructions and the patients should fall in line with the program. This can also translate into a desire to control every aspect of a case. As a result, they often face little resistance—they are the overseers of the case and conflict simply does not arise in that context. Referring patients can be difficult because of this desire to manage every aspect of patient care. Dentists may also have difficulty delegating tasks, preferring instead to perform each procedure themselves. This reflects their fundamental view that they are ultimately responsible for their patients. Often this means that they do not collaborate well with the rest of the health care profession. They see themselves as solo practitioners. Dentists are often poor at giving feedback and even poorer at receiving it. They tend to be perfectionists and see criticism as a threat. Falling short of the goal affects their view of their reputation and could potentially have medicolegal implications. They tend to avoid interactions that include critiques and feedback exchange. Leaders.—Leaders do not have direct authority over every situation, so they must understand and navigate through the sociopolitical and cultural environment and employ negotiation and persuasion to get things done. They require the ability to influence others to support goals and actions. This is an influential relationship rather than a transactional one. Leaders also know how to operate effectively in a team. They know each member of the team, inspire them, and identify the personal value in achieving organizational
298
Dental Abstracts
goals. The team then buys into meeting the goals. Leaders use their charisma and communication skills to create an environment where team members can succeed individually in their pursuit of the organizational goals. Rather than the leader being solely responsible, as with dentistmanagers, responsibility is shared among the team. Good leaders may be less detail oriented than managers. Instead, they have a ‘‘big picture’’ mentality that considers not just individuals but also the entire organization, competing entities, and even the surrounding population or area. Expertise is shared with the team. As a result, leaders feel comfortable delegating and see it as a way to engage with the team as well as reduce their workload. Delegation also enhances the confidence and commitment of the team, further strengthening it. Leaders often do not have the well-defined problems facing them that a dentist routinely handles. Instead, leadership is a complex task with many changes taking place. Many factors are involved and the resolution of a problem can often require counterintuitive steps. Leaders need to understand the implications of their decisions, consider them all, and act. Leaders must also be open to the feedback of many entities. Without gathering feedback and considering others’ opinions the best option may be overlooked. They are adept at evaluating data and assessing how to use it. With the move toward publicly available patient satisfaction data being made by hospitals and other medical or insurance entities, leaders will need to be open to dealing with both negative and positive feedback. Leaders also are able to communicate effectively with large groups, sharing their vision and building a foundation for these individuals to buy into their team and organization. Dentists need to be empathetic and able to communicate
one-on-one, whereas leaders need to effectively employ broad communication skills for a wide range of applications. Althoughdentistsareseenhistoricallyaspatientor tolerant, leaders often cannot afford to wait. They instead tend to be proactive, plan ahead, and can be impatient with delays. Leaders must be transparent and honest, optimistic, and intuitive. Society may have some qualms about the honesty of dentists based on past history. In addition, dentists tend to have a more pessimistic bent, thinking of the possible poor outcomes and worst possible scenarios for patients to meet medico-legal requirements. Dentists often do not take risks and tend to rely on information rather than intuition. Discussion.—If the future of dentistry is larger practices, staff management needs, complex marketing demands, and financial decisions, dentists will require more leadership skills in many cases. Although they possess
characteristics and natural abilities that make them good dentists, these same traits can hinder their ability to lead.
Clinical Significance.—The American Dental Association (ADA) and other dental organizations offer leadership training programs that may benefit dentists. These should be considered essential learning opportunities that will strengthen dentists and their staff.
Nalliah RP: Do dentists make poor leaders? Br Dent J 220:389-391, 2016 Reprints available from RP Halliah, Univ of Michigan School of Dentistry, Patient Services, 1011 N University, Ann Arbor, MI 48105; e-mail: [email protected]
EXTRACTS DRINK WATER FOR HEALTH All the cells, organs, and tissues of the body need water to function properly. Water helps dissolve minerals and nutrients so they are more available for use and it transports waste products out of the body. The body loses water through sweating and urination or even breathing, and it must be replenished regularly. Some water comes through foods with a high water content, but the majority comes from drinking water and other beverages. Although there are individual variations, the Institute of Medicine (IOM) reports an adequate intake of 13 cups (3 liters) a day for men and 9 cups (2.2 liters) for women. Water is especially indispensable for the kidneys. These two fist-sized organs are shaped like beans and found in the middle of the back on either side of the spine and just under the rib cage. ‘‘The role of the kidneys is often underrated when we think about our health,’’ states Kidney Health Australia. ‘‘They are so important to health that nature gave us two kidneys to cover the possibility that one might be lost to an injury. They are so important that with no kidney function, death occurs within a few days.’’ Specific roles include removing waste products and excess fluid from the body via urine, regulating levels of salt, potassium, and acid in the body, and producing hormones to regulate other organs. If the kidneys do not function properly, waste products and excess fluid can build up in the body, which can lead to chronic kidney disease, painful kidney stones, or urinary tract infections. Dehydration can also lead to an imbalance in the electrolyte levels of the body, which can mix up electric signals and produce seizures. Severe dehydration can also be associated with kidney failure, anemia, central nervous system damage, heart failure, and immune system compromise. A study by the Centers for Disease Control and Prevention (CDC) in 2013 used data from the National Cancer Institute’s 2007 Food Attitudes and Behaviors Survey and found that of 3397 adults, 7% did not drink water daily, 36% drank only 1 to 3 cups per day, 35% drank 4 to 7 cups, and 22% drank 8 or more cups. Those who drank less than 4 cups of water a day tended to consume less than 1 cup of fruits or vegetables daily. Water is the ideal way to provide fluid to the body because it is readily available and free of calories, caffeine, and alcohol. The CDC suggests that people increase their water intake by carrying a water bottle that makes it accessible anywhere; freezing water in bottles to provide a supply of ice-cold water, which is often more satisfying than other beverages; and adding a wedge of lime or lemon to improve the taste of water without altering its nutritional value. [McIntosh J: Satisfying Thirst and the Kidneys: The Importance of Drinking Water. Medical News Today, accessed at http://www.medicalnewstoday.com/articles/290814.php]
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Issue 6
2016
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